More than half of Virginia’s state-run psychiatric hospitals are closing for new admissions

More than half of Virginia’s state-run mental hospitals are closing immediately for new admissions, the Department of Behavioral Health and Developmental Services announced Friday.

The abrupt order from DBHDS Commissioner Alison Land comes amid a labor crisis that has resulted in a “dangerous environment where staff and patients are at increased risk of physical injury,” she wrote in a letter to providers across the state.

Five facilities – Catawba Hospital, Central State Hospital, Eastern State Hospital, Piedmont Geriatric Hospital and Western State Hospital – were ordered to reduce their bed capacity and consolidate staff. As a result, these hospitals will “temporarily” close to new admissions, Land wrote, though she gave no indication of how long the order would last.

The dramatic reduction in beds is a new low for the state’s besieged mental hospitals, which for years have struggled with an unsustainable increase in patient admissions. In 2014, Virginia passed legislation now commonly known as its “last resort“bill. The bill was sponsored by Senator Creigh Deeds, D-Bath, after his own son killed himself and seriously injured Deeds during a mental crisis.

Under the state code, Virginia’s psychiatric hospitals are required to admit patients after an eight-hour period if a bed cannot be found at another facility, including private hospitals with behavioral health units. As a result, these private hospitals have become more and more reluctant to admit psychiatric patients, especially if they experience complex or aggressive symptoms.

The burden has fallen on state hospitals to accept these patients, which has resulted in a wave of new admissions over the last many years. The state is increasingly dealing with what is often referred to as “inappropriate admissions”- patients with complex medical needs who cannot be treated in the public psychiatric facilities.

Since the law came into force, the number of hospitalized patients has been through temporary detention orders – which requires mental health evaluations and treatment – has risen from 3.7 a day to 18 or more a day, an increase of 392 percent, Land said.

“Keep in mind that all operational activity to support and treat this huge increase in patients also increased proportionately,” she wrote. But in the same period, the staff level has plummeted across the facilities. Nearly 30 percent of all positions are vacant, with vacancies closer to 40 percent at some hospitals. The Commonwealth Center for Children and Adolescents – the only state hospital that can accommodate minors – serves only 18 of its 48 beds due to low staffing.

“We have seen 108 new layoffs over the last two weeks,” Land wrote. “For years, DBHDS has been trying to mitigate its staffing level with international nurses, locum tenens [temporary staffers] and other staff contracts. Not only are these staffing contracts incredibly expensive – sometimes three times our regular staff pay – but now contract staff are increasingly not renewing or leaving until their contract expires. “

These deficiencies have made it impossible to treat patients safely, according to DBHDS. Land said there have been 63 serious injuries among staff and patients since July 1, with an average of 4.5 serious incidents across the hospital system each day.

The conditions give Lane “the responsibility (and authority)” to stop new admissions “to protect the safety of her staff, patients and facilities,” Alena Yarmosky, a spokeswoman for Governor Ralph Northam, wrote in an email Friday.

“Despite significant investment from the state, Virginia’s mental health hospitals have operated at extremely high census levels for several years – and the COVID-19 pandemic has made this situation even more challenging,” she added. “That’s why Governor Northam will propose a significant amount of funding from the U.S. Rescue Plan to increase staff salaries, hire critical staff and ensure the well-being of patients and staff.”

As beds are consolidated, DBHDS will work on each of the five facilities on a staff pooling and discharge plan, according to spokeswoman Lauren Cunningham. Lane said the agency will continue to follow the necessary security procedures and that the reduction in bed space will come “through wear and tear.”

What is not immediately clear, however, is how Virginia’s mental health infrastructure will be affected by the sudden loss of beds.

For months, law enforcement officials have sounded the alarm over long waits at local emergency rooms, where officers and patients often spend days waiting for a psychiatric bed to open at a state or private facility. DBHDS urges hospitals across the state to accept new patients, “even those patients who may be challenging or may need behavior management.”

“My sincere hope is that this hospital closure will not last a day longer than it should,” Land wrote. “We will continue to work diligently to find solutions to improve the staff-patient relationship and plan to reopen beds step by step as staff levels improve.”

Julian Walker, vice president of communications for the Virginia Hospital and Healthcare Association, said private hospitals regularly discuss capacity issues with DBHDS and will accept new psychiatric patients “if options and beds are available.”

“If patients who cannot be accommodated in the state system can be accommodated in a private hospital, it will be evaluated by the clinicians and nursing staff,” he said. “But at the same time, in general, if there are patients who have specific needs and challenges that are to a degree that would make them disruptive or have outbursts against staff or other patients, then that is also a factor in the evaluation. “

Walker said private hospitals, which generally have more beds than state-run facilities, have also seen a dramatic increase in psychiatric needs throughout the pandemic. Systemically, staff and capacity are a major concern for Virginia’s overall mental health system.

Jennifer Faison, executive director of the Virginia Association of Community Service Boards, told Mercury that labor shortages are the “primary challenge” facing local agencies that provide safety net services to patients with mental illness. Many private hospitals are also experiencing huge patient backlogs, including the Children’s Hospital of The King’s Daughters in Norfolk, which currently has over 1,600 children on the waiting list for its mental health program.

“The unfortunate reality right now is that the strain that the state system is experiencing is also being experienced by the private hospital community, in terms of staff, in terms of capacity,” Walker said. “The reality is that the difficulties we are experiencing now can get worse before they get better.”

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